Provider Demographics
NPI:1003434036
Name:GIBBONS, STEVEN JAMES (RECOVERY COACH)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:JAMES
Last Name:GIBBONS
Suffix:
Gender:M
Credentials:RECOVERY COACH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 QUINCY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-6764
Mailing Address - Country:US
Mailing Address - Phone:857-939-1363
Mailing Address - Fax:
Practice Address - Street 1:85 QUINCY AVE STE B
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-6764
Practice Address - Country:US
Practice Address - Phone:857-939-1363
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-07-07
Last Update Date:2020-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty